Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Populat

[oceanblue]

That's just it.....if they actually had to justify most of what they do, there is just no way they could......the problem is that they haven't been held accountable yet by anyone who has any actual power over them

I know, it's so frustrating. Sometimes, I fantasise:

Errant scientist called to see the Headmaster:

"Nater, come here!

I've just read your paper and it's complete garbage! [sound effect: Rrrriiiiipppp]

You use a dodgy case definition that includes people who don't do much because they have psychological problems then conclude that people with the illness have psychogical problems. What do we call that? Yes: a ciruclar argument! Don't do it!

Then you make up a Personality Disorder that was explicitly rejected by the American Phsychological Association - what do you think are you playing at?!

But even then you find that the level of personality disorders in CFS is similar to that of other chronic illness - so it can't have anything to do with the cause of this illness, can it? Especially as even by your definitions most patients don't have a personality disorder! Where is the intellectual rigour in all this?

The worst thing is you do actually know all this because you admit it the discussion section. So what exactly is the point of publishing this nonsense?! The idea of research is supposed to be advancing scientific knowledge, not your standing with your friends.

And how may times have I told you not to quote references misleadingly? Yes, I read the Taillefer reference and it actually says that neuroticism was only higher in CFS patients with comorbid depression - it was lower in CFS patients without depression. So that's evidence against your point not for it - an important distinction to make in proper science, Nater.

And what's your speculation doing in the abstract, for goodness sake? In the conclusion section! Conclusions are things you've proved by your research, not things you wish were true!

I've had enough of this. You can stay behind tonight and write lines - 100 of each of these:

"I must not fib about what references say"
"I must not try to pass off my opinions as the findings of proper research"
"The purpose of research is to find the true nature of things, not to impress my mates"

Tell the rest of your gang who were in on this - Reeves, Heim, the lot of them - I want the lines from them too.

Maybe one day I'll turn you all into proper scientists.

Sigh....

Now, get out of my sight."

--- fantasy fades......

Well, it makes me feel better.

The whole of idea of scientific publication is built around Peer Review, where your work is scrutinised by your peers before it is accepted for publication. In many fields this can be a bloody process, with researchers trying to undermine their rival's papers with hostile reviews. But the results is fierce scrutiny and better quality work. In the field of ME/CFS, peer review seems to be no more than a slap on the back from your mates.

The reality is that nothing will change and research like this will continue to be published. It makes me want to weep.

 

[Dolphin]

Great analysis, oceanblue. And humour is always welcome! :Retro smile:

 

[BEG]

"Discussion:
Our results suggest that CFS is
associated with increased prevalence of maladaptive personality
features and PDs.

It might be assumed that these persons are more
likely to be non-compliant to treatment suggestions, display unhealthy
behavioral strategies, and lack a stable social environment.

The question arises whether personality dispositions are a premorbid risk
factor or whether they are a consequence of the chronicity and severity
of CFS."


Reeves and the CDC give me a big PD. That's a personality disposition characterized by venemous, embroiling, scorching rage. Premorbid? Hah! It was cultivated over the years by inane idiots at the CDC, masquerading as scientists. As I lose day after day to the walking death syndrome, this PD grows exponentially as the CDC becomes dumber (their own PD.) The question arises whether their PD is a risk factor for researching CFS or a consequence of conducting their insane research.

In any case, Reeves is a sick man with a maladaptive personality feature, a reluctance to accept true science. I believe his friends at Emory should help him before his PD diminishes his capacity to function even in his own little world.

 

[oceanblue]

Great analysis, oceanblue. And humour is always welcome! :Retro smile:

Hey, delighted you liked the analysis! The piece was really just a bit of therapy for me (and I feel much better for it).

 

[Dolphin]

I sent in the following letter today to the corresponding author:



Im not sure I should post the reply but basically he has passed the request on to Elizabeth Unger (not one of the authors) as he no longer works in the CDC CFS section and doesn't want to deal with it.
Anyone else written to him? Wonder is this different treatment for non-academics? This paper has only just been published. I've requested such info before from corresponding authors and never had problems (including with Peter White who probably doesn't like me!) Elizabeth Unger wasn't involved as I said so won't have the info probably.

She has sent it on now so no inordinate delay.

 

[SOC]

I know, it's so frustrating. Sometimes, I fantasise:


--- fantasy fades......

Well, it makes me feel better.

The whole of idea of scientific publication is built around Peer Review, where your work is scrutinised by your peers before it is accepted for publication. In many fields this can be a bloody process, with researchers trying to undermine their rival's papers with hostile reviews. But the results is fierce scrutiny and better quality work. In the field of ME/CFS, peer review seems to be no more than a slap on the back from your mates.

The reality is that nothing will change and research like this will continue to be published. It makes me want to weep.

Thanks for the new fantasy!

I do wonder who the heck is "peer-reviewing" and approving this BS. It really brings Retrovirology's scientific ethics into question, IMO.

 

[Dolphin]

I have just taken a quick look at the table of correlations between the eight SF-36 and the 5 personality features and also the five MFI20 subscales and the five personality features.
One very clear that thing is that the personality features are associated with poor health/quality of life/fatigue in all of the three groups. For the CFS group, there are 28 out of a possible 65 statistically significant correlations. The figures for ISF and the control group are 43 (!) and 25.

If one breaks down into the five personality factors, across the three groups there are the following number of correlations:
Column 1: Neuroticism: 27 correlations (out of a possible 39)!
Column 2: Extraversion: 26 correlations (out of a possible 39)
Column 3: Openness: 9 correlations (out of a possible 39)
Column 4: Agreeableness: 12 correlations (out of a possible 39)
Column 5: Conscientiousness: 22 correlations (out of a possible 39).

So in total 96 out of a possible 195.
It was by chance, it would be 9.75. I'm sure this is statistically significant.

Note: higher SF-36 subscale scores (first eight) equals more function/better quality of life. Higher MFI20 subscale scores (last five) equals worse fatigue and the like. Positive correlations mean as one goes up, the other goes up also. Negative correlations mean, as one goes up, the other gets lower.

Chronic Fatigue Syndrome (CFS), Persons with Insufficient Symptoms or Fatigue (ISF) and Well Controls (Well)
CFS
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Physical Functioning -.017 .023 .109 -.094 .034
Role Physical -.052 .125 -.026 -.163 -.013
Bodily Pain .060 .004 .062 -.078 -.113
General Health -.162 .128 .149 -.029 .152
Vitality -.384(**) .334(**) .126 -.084 .089
Social Functioning -.419(**) .349(**) .241(*) .062 .200(*)
Role Emotional -.564(**) .361(**) .310(**) .220(*) .211(*)
Mental Health -.731(**) .469(**) .327(**) .318(**) .371(**)
General Fatigue .240(*) -.150 -.041 .182 -.070
Physical Fatigue .125 -.085 -.051 .165 .015
Reduced Activity .180 -.223(*) -.201(*) .020 -.275(**)
Reduced Motivation .405(**) -.394(**) -.204(*) -.057 -.333(**)
Mental Fatigue .503(**) -.284(**) -.190(*) -.011 -.500(**)

** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).


ISF
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Physical Functioning -.172(**) .299(**) .112 .076 .150(*)
Role Physical -.056 .141(*) .110 .125(*) .059
Bodily Pain -.105 .133(*) .057 .158(*) -.034
General Health -.351(**) .338(**) .113 .202(**) .199(**)
Vitality -.442(**) .436(**) .052 .113 .247(**)
Social Functioning -.362(**) .249(**) .068 .170(**) .110
Role Emotional -.364(**) .219(**) -.041 .193(**) .165(**)
Mental Health -.679(**) .375(**) .061 .200(**) .252(**)
General Fatigue .353(**) -.313(**) -.040 -.088 -.193(**)
Physical Fatigue .259(**) -.320(**) .001 -.096 -.235(**)
Reduced Activity .219(**) -.462(**) -.071 -.053 -.336(**)
Reduced Motivation .375(**) -.512(**) -.122(*) -.140(*) -.414(**)
Mental Fatigue .442(**) -.225(**) -.008 -.197(**) -.288(**)

** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).



Well
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Physical Functioning -.279(**) .094 .186(*) -.014 .010
Role Physical -.168 .166 -.075 .177(*) .133
Bodily Pain -.192(*) .131 .070 .090 .045
General Health -.266(**) .237(**) .090 .062 .187(*)
Vitality -.298(**) .197(*) -.072 .067 .250(**)
Social Functioning -.165 .118 -.176 .196(*) .021
Role Emotional -.118 .222(*) -.194(*) .162 .091
Mental Health -.454(**) .190(*) -.134 .087 .136
General Fatigue .276(**) -.055 .056 .037 -.146
Physical Fatigue .248(**) -.128 .000 -.011 -.257(**)
Reduced Activity .168 -.265(**) .009 -.030 -.314(**)
Reduced Motivation .283(**) -.306(**) -.133 -.157 -.339(**)
Mental Fatigue .362(**) -.103 .022 .007 -.262(**)

** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

 

[Dolphin]

Is he uncomfortable with his own work?

He's certainly might be uncomfortable with many people reading that table - it pretty much means that one can't read anything into the personality features data.

It would be very interesting if they prepared and presented a similar table of correlations with the personality disorders. My guess is that they did prepare at as all the data is in the computer. We're just not getting to know what they found.

 

[Hope123]

Hey, I haven't read this article or all the posts but Dolphin's post above clued me in that this is the personality test they're looking at:

http://en.wikipedia.org/wiki/Big_Five_personality_traits

 

[oceanblue]

I have just taken a quick look at the table of correlations between the eight SF-36 and the 5 personality features and also the five MFI20 subscales and the five personality features.

One very clear that thing is that the personality features are associated with poor health/quality of life/fatigue in all of the three groups. For the CFS group, there are 28 out of a possible 65 statistically significant correlations. The figures for ISF and the control group are 43 (!) and 25.

You've clearly been very busy well into the night! A hugely impressive effort to gather this additional data and analyze it. You said:

[it] pretty much means that one can't read anything into the personality features data.

Could you expand on this a bit? Some of us are a bit mesmerized by so much data. Are you effectively saying you could draw a huge number of different conclusions from the data, depending on what you wanted to highlight, or that nothing is significant at all? It seems to me that you are saying something very important about the validity of the reserach, but I haven't quite grasped it.

Thanks

 

[Dolphin]

Could you expand on this a bit? Some of us are a bit mesmerized by so much data. Are you effectively saying you could draw a huge number of different conclusions from the data, depending on what you wanted to highlight, or that nothing is significant at all? It seems to me that you are saying something very important about the validity of the reserach, but I haven't quite grasped it.

Thanks

Thanks Oceanblue.
They ran two sets of tests relating to personality.

If one looks at the table above, one can see that for the personality features test, what one sees for all the groups (CFS, ISF and controls) is that the scores on the personality features test correlate with a lot of scores on the quality of life and fatigue measures. This could be said to mean that nothing CFS-specific has been found - all, in a way, one is doing when one measures neuroticism or whatever is measuring quality of life/fatigue rather than a separate independent marker. There is the possibility the direction of causation is the other way of course and the personality features cause the lower scoring. But it is the case across the three groups and it not clear how plausible that would be, across society, for extraversion for example.

Of course, the main issue in the study is the Personality Disorders data. There is no mention of them looking at whether there are any correlations between it and the SF-36 and MFI20 subscales - if it did find the same sorts of correlations (which they could do easily with the data in the computer), it would again suggest the researchers didn't find anything interesting. Perhaps such data exists from other research, I don't know.

 

[oceanblue]

[the table shows] that for the personality features test, what one sees for all the groups (CFS, ISF and controls) is that the scores on the personality features test correlate with a lot of scores on the quality of life and fatigue measures. This could be said to mean that nothing CFS-specific has been found - al,l in a way, one is doing when one measures neuroticism or whatever is measuring quality of life/fatigue rather than a separate independent marker. There is the possibility the direction of causation is the other way of course and the personality features cause the lower scoring. But it is the case across the three groups and it not clear how plausible that would be, across society, for extraversion for example.

So, they found nothing that links personality traits specifically to CFS, at least not causally, not even neuroticism. Shame they didn't put this in the abstract. The table of data you extracted from them relly does reinforce the 'so-whatness' of their findings. I guess that's why they left it out.

 

[Tammie]

Hey, I haven't read this article or all the posts but Dolphin's post above clued me in that this is the personality test they're looking at:

http://en.wikipedia.org/wiki/Big_Five_personality_traits

looking this over, I noticed something else that could easily skew the tests........there are a lot of "reverse" questions, and I have read elsewhere that people with cognitive difficulties have a hard time processing these questions properly and as a result answer them backwards to what they really mean

for exp, here are some sample questions:

"Sample openness items

* I have a rich vocabulary.
* I have a vivid imagination.
* I have excellent ideas.
* I spend time reflecting on things.
* I use difficult words.
* I am not interested in abstractions. (reversed)
* I do not have a good imagination. (reversed)
* I have difficulty understanding abstract ideas. (reversed)"

Though these may look obvious to a lot of people, it has been shown that when someone with cognitive difficulties reads questions like this, they sort of miss the way that the questions flip from "I am" to "I am not" and they cont to answer them as they would if all the questions said, "I am". Obviously this will not give accurate results!

and then there are these:

"Sample conscientiousness items

* I am always prepared.
* I am exacting in my work.
* I follow a schedule.
* I get chores done right away.
* I pay attention to details.
* I leave my belongings around. (reversed)
* I often forget to put things back in their proper place. (reversed)
* I shirk my duties. (reversed)"

Even if interpreted properly, it is not hard to understand why someone sick with ME/CFS might answer these in a way that would indicate (in a healthy person) a lack of conscientiousness, but in us just indicates we are too darn sick to do some of these things!

And still some more,

"Sample extroversion items

* I am the life of the party.
* I don't mind being the center of attention.
* I feel comfortable around people.
* I start conversations.
* I talk to a lot of different people at parties.
* I am quiet around strangers. (reversed)
* I don't like to draw attention to myself. (reversed)
* I don't talk a lot. (reversed)
* I have little to say. (reversed)"

yeah, us ME/CFS peeps have the energy to be the life of the party, and if we are not, it must mean we are introverted! and the rest can be issues due to cognitive problems, fatigue, etc, and once again say absolutely nothing about how introverted/extroverted we are

 

[Snow Leopard]

Besides the unreliability of questionnaires, the problem with these sorts of studies is often selection bias - out of those who have CFS, those who have certain personality types might simply be more likely to participate in such studies. Unfortunately, this possibility seems to be rarely examined or even discussed in this sort of research.

Of course I don't have access to this article and most of that 29% might just have depression.

 

[Dolphin]

Besides the unreliability of questionnaires, the problem with these sorts of studies is often selection bias - out of those who have CFS, those who have certain personality types might simply be more likely to participate in such studies. Unfortunately, this possibility seems to be rarely examined or even discussed in this sort of research.

I think that is a bigger criticism of all the other studies than have been done than this one. This was only a small part of testing they did (for three days?). And people were selected from by random digit phoning.

Of course I don't have access to this article and most of that 29% might just have depression.

This is certainly a possibility given it uses the empiric criteria (Reeves et al, 2005). But we are not given information on the individuals. And it will probably appear to most readers that the Fukuda criteria was used and this is a good random selection of CFS patients.

 

[Enid]

Quite agree CFS so called is simply one aspect of the severe pathologies now known. All illnesses produce fatigue as does ME. About time Myalgic Encephelomyalitis was reinstated.

 

[Dolphin]

This is certainly a possibility given it uses the empiric criteria (Reeves et al, 2005). But we are not given information on the individuals. And it will probably appear to most readers that the Fukuda criteria was used and this is a good random selection of CFS patients.

I forgot to say that we know information about the cohort of CFS patients in general (but not which have personality disorders etc) from other studies e.g.
http://www.ncbi.nlm.nih.gov/pubmed/19414619

Psychosom Med. 2009 Jun;71(5):557-65. Epub 2009 May 4.

Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population.

Nater UM, Lin JM, Maloney EM, Jones JF, Tian H, Boneva RS, Raison CL, Reeves WC, Heim C.

Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Comment in:
Psychosom Med. 2010 Jun;72(5):506-7; author reply 507-9.

Abstract

OBJECTIVE:
To compare the prevalence of psychiatric disorders in persons with chronic fatigue syndrome (CFS) identified from the general population and a chronically ill group of people presenting with subsyndromic CFS-like illness ("insufficient symptoms or fatigue" (ISF)).

Previous studies in CFS patients from primary and tertiary care clinics have found high rates of psychiatric disturbance, but this may reflect referral bias rather than true patterns of comorbidity with CFS.

METHODS:
We used random digit dialing to identify unwell individuals.

A detailed telephone interview identified those with CFS-like illness.

These individuals participated in a 1-day clinical evaluation to confirm CFS or ISF status.

We identified 113 cases of CFS and 264 persons with ISF.

To identify current and lifetime psychiatric disorders, participants completed the Structured Clinical Interview for DSM-IV.

RESULTS:
Sixty-four persons (57%) with CFS had at least one current psychiatric diagnosis, in contrast to 118 persons (45%) with ISF.

One hundred one persons (89%) with CFS had at least one lifetime psychiatric diagnosis compared with 208 persons (79%) with ISF.

Of note, only 11 persons (9.8%) with CFS and 25 persons (9.5%) with ISF reported having seen a mental healthcare specialist during the past 6 months.

CONCLUSIONS:
Our findings indicate that current and lifetime psychiatric disorders commonly accompany CFS in the general population.

Most CFS cases with comorbid psychiatric conditions had not sought appropriate help during the past 6 months.

These results demonstrate an urgent need to address psychiatric disorders in the clinical care of CFS cases.

 

[justinreilly]

I agree that now casting us as having personality disorders is very smart since pwPD generally have 'defective', amoral or immoral characters- they are generally narcissistic, manipulative, irrational, abusive and always think they are right and anyone who opposes them are wrong no matter the evidence. This is perfect for them to allege since they can say 'these people are manipulative and will never take responsibility for their own laziness and craziness so they try to blame us innocent CDC scientists.'

...Sorry but they can just kiss my ...whatever.......I used to think, well they're digging down into cortisol - its no big deal - it's never going to fix CFS but at least they're finding something - but they've just bottomed out here. Ugh....

The sexual abuse studies turned the CDC's heads. If they are spending money looking for personality disorders they're lost......this program is lost, lost, lost. They've finally become as bad as everybody's said they are....
[emphasis added]

finally?????? It's clear to me and almost everyone else who's been following CDC that they've been this bad and waging a PR war on ME patients and science since day one. Just to cite two example out of scores:

-remember the fact that the misappropriated at least tens of millions of dollars from the "CFS" budget from the beginning until 1999- in most years almost the entire "CFS" budget- and lied in their testimony to Congress year-in and year-out about it.

-remember the "Dear Sirs, I am sick" joke letter they had up on their community bulletin board for a year and a half until Hillary Johnson saw it with the hysterical "CFS" patient saying "the [antipsychotics] only work when I take them."

Cort, Please don't give cover to these criminals by suggesting that they have been mostly trying their best (as you said in your blog post) and that only very recently have they gotten really bad. IMO this is a huge disservice to ME patients.

 

[justinreilly]

A previous CFS study which found a rate of 12% (same as controls)

Full text free at: http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0812C&L=CO-CURE&P=R474&I=-3

Chronic fatigue syndrome and DSM-IV personality disorders

J Psychosom Res. 2009 Jan;66(1):13-20. Epub 2008 Nov 22.

Courjaret J, Schotte CK, Wijnants H, Moorkens G, Cosyns P.

Department of Psychiatry, University Hospital Antwerp, Edegem, Belgium. kim.courjaret@uza.be

Abstract

OBJECTIVE:
Personality is an important factor in the research of the chronic fatigue syndrome (CFS).

Although some studies report a high rate of personality disorders--around the 40% level--in samples of patients with CFS, the generalizability of these findings can be questioned.

The present study evaluates the prevalence of Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) personality disorders in a sample of female CFS patients and in two control groups.

METHOD:
The ADP-IV questionnaire (Assessment of DSM Personality Disorders IV) was used to assess the DSM-IV-TR personality disorders at a dimensional and categorical level in a sample of 50 female CFS patients and in two matched control samples of Flemish civilians (n=50) and psychiatric patients (n=50).

RESULTS:
The results indicate a striking lack of statistical significant differences between the CFS sample and the Flemish control group at the level of dimensional Trait scores, number of criteria, and prevalence rates of personality disorder diagnoses.

Unsurprisingly, higher scores at these levels were obtained within the psychiatric sample.

The prevalence of an Axis II disorder was 12% in the Flemish and CFS samples, whereas the psychiatric sample obtained a prevalence of 54%.

CONCLUSION:
The prominent absence of any significant difference in personality disorder characteristics between the female Flemish general population and the CFS samples seems to suggest only a minor etiological role for personality pathology, as defined by the DSM-IV Axis II, within CFS.

Notice how biased these people are. Why does the same rate of Axis II disorders in normals and ME patients "suggest only a minor etiological role for personality pathology, as defined by the DSM-IV Axis II, within CFS"? It obviously suggests NO etiological role for personality disorders, not "a minor role."

It never ceases to amaze me what anti-science garbage on ME gets published.

 

[justinreilly]

Oh, I forgot to ask:

WTF is ISF? All I saw was ISF (insufficient fatigue). Insufficient fatigue? Really? What does that mean? It sounds like something I might want.

Ha! I'd like insufficient fatigue and 'chronic unwellness'. Sounds like a blast compared to the hell of ME.